Name of Manual - Blue Cross and Blue Shield of Minnesota

Medication Therapy
Management (MTM)
(continued)
Coding Policies and Guidelines (Medical Services)
Code Definition Allowed Frequency
99605 Medication Therapy Management
Service(s) provided by a
pharmacist, individual face to face
with patient, with assessment and
intervention if provided; initial 15
minutes, new patient.
99606 Medication Therapy Management
Service(s) provided by a
pharmacist, individual face to face
with patient, with assessment and
intervention if provided; initial 15
minutes, established patient.
99607 Medication Therapy Management
Service(s) provided by a
pharmacist, individual face to face
with patient, with assessment and
intervention if provided; each
additional 15 minutes (list
separately in addition to code for
primary service)
Pricing and programs applicability
1 per enrollee per
year
Up to 7 per enrollee
per year
Up to 4 per enrollee
per date of service
Blue Cross has incorporated DHS rates in the usual pricing
methodology for Public Programs for these codes. This
information applies to the following programs and group numbers:
Prepaid Medical Assistance Program (PMAP & GAMC) – all
groups beginning with PP0 (Members with Medicare must get
these services through their Medicare Part D plan).
SecureBlue – all groups beginning with PP2 (Members with
Medicare must get these services through their Medicare Part
D plan for Medicare-covered services).
Minnesota Senior Care – all groups beginning with PP0
(Members with Medicare must get these services through their
Medicare Part D plan).
MinnesotaCare – Expanded (PP111, PP112, PP151, PP152),
Basic Plus (PP161, PP162, PP163, PP164), Basic + One
(PP121, PP122), and Basic + 2 (PP131, PP132, PP141,
PP142).
This benefit is not covered under the Limited Benefit Set (PP171,
PP172).
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)
11-39